Obesity and the Metabolic Syndrome in Children and Adolescents by Jan Foster, MS, RD, LDN – September 2004

The results of a new study just published in the New England Journal of Medicine suggest that the metabolic syndrome is far more common among children and adolescents than previously reported. Also, it seems that its prevalence increases directly with the degree of obesity. Moreover, each element of the syndrome worsens with increasing obesity—an association that is independent of age, sex, and pubertal status. Furthermore, this study implicates that, as in obese adults, insulin resistance in obese children is strongly associated with specific adverse metabolic factors.

The metabolic syndrome is described as a link between insulin resistance and hypertension, dyslipidemia, type 2 diabetes, and other metabolic abnormalities associated with an increased risk of atherosclerotic cardiovascular disease in adults. Obesity, which is the most common cause of insulin resistance in children, is also associated with dyslipidemia, type 2 diabetes, and long-term vascular complications.

Though some of the criteria used in determining the metabolic syndrome for adolescents must be modified from those used for adults, the basic standards may be used. Metabolic syndrome is present if three or more of the following criteria for age and sex are met:  a BMI above the 97th percentile, a triglyceride level above the 95th percentile, and HDL cholesterol level below the 5th percentile, systolic or diastolic blood pressure above the 95th percentile, and impaired glucose tolerance.

It may be that the metabolic syndrome phenotype remains over time and progresses clinically. This study reported that in a preliminary follow-up, 8 of the subjects who met the criteria for metabolic syndrome, developed full blown type 2 diabetes. The increase in the incidence of type 2 diabetes may be the initial indicator for an epidemic of advanced cardiovascular disease due to the synergistic effects of other components of the metabolic syndrome, as well as chronic low-grade inflammation, as obese adolescents become obese young adults.

(Study by Weiss R, Dziura J, Burgert T, Tamborlane W, Taksali, S, Yeckel C, Allen K, Lopes M, Savoye M, Morrison J, Sherwin R, Caprio S. Obesity and the Metabolic Syndrome in Children and Adolescents. N Engl J Med. 2004; 350: 2362-74)